Carbon Monoxide Brain Toxicity: Clinical, Magnetic Resonance Imaging, Magnetic Resonance Spectroscopy, and Neuropsychological Effects in 9 People

Abstract

Carbon monoxide (CO) exposure is a common cause of toxic brain damage, whereby effects range from transient neurological dysfunction to coma and death. A spectrum of severity of magnetic resonance imaging (MRI) findings after CO brain toxicity, including globus pallidus and white matter lesions, is well documented. Reports of MR spectroscopy (MRS) findings re main sparse. This article reports 9 people exposed to CO because of an apartment house's faulty gas heater. Four, with transient loss of consciousness after chronic moderate level CO exposure, suffered intellectual impairment without MRI abnormalities. The MRS of 1 individual demonstrated decreased n-acetyl aspartase in the basal ganglia, bilaterally. Of 5 exposed to high levels for about 12 hours, 1 died prior to clinical and/or MRI evaluation. One who suffered coma recovered but was lost to evaluation. Three, who were unconscious for hours to days, exhibited T2 MRI white matter signal abnormalities. MRS showed decreased basal ganglia n-acetyl aspartase in 2. One of these suffers a Parkinsonian syndrome. All 3 are intellectually impaired. This study demonstrates that although MRI and MRS are useful markers of CO-induced brain damage, they are not always sensitive to resultant intellectual dysfunction.

Carbon monoxide intoxication: An updated review

“…The classic cherry-red discoloration of the skin and cyanosis are rarely seen [19]. Varying degrees of cognitive impairment have been reported [23]. Table 1 lists some of the symptoms and signs of CO intoxication.…”

“…NAA decreases in demyelinated white matter presumably represent axonal and neuronal loss [51]. MRS provides evidence for CO-induced brain damage including decreased NAA found in the basal ganglia and elsewhere [23].…”

The allegory of a mountain: An environmental introduction to neurotoxicology

“…In some cases of neurotoxic damage, encephalopathy occurs. Occasionally, neuroimaging studies such as brain computerized tomography (CT), magnetic resonance imaging (MRI), MR spectroscopy, and PET/SPECT scans provide useful information [17,18]. In other such cases, neuropsychological assessment provides relevant data [19,20].…”

“…MRS showed decreased basal ganglia n-acetyl aspartase in two. One of them suffers a Parkinsonian syndrome and all 3 are intellectually impaired [17].…”

Intoxication aiguë au monoxyde de carbone et séquelles neurologiques : de la physiologie à la clinique

“…Elle met en évidence des lésions de démyélinisation ainsi que des lésions pétéchiales hémorragiques, siégeant préférentiel-lement au niveau de la substance blanche notamment en périventriculaire [41][42][43][44] et au niveau des ganglions de la base, avec une prédilection plus marquée pour le globus pallidum et l'hippocampe [40,44] que pour les lobes temporaux médians et frontaux [37,45]. Une atrophie du fornix à l'IRM cérébrale a aussi été rapportée [46,47].…”